Wound Closure Flashcards
What are 4 classifications of wound closure?
- Primary Closure
- Delayed Primary Closure
- Secondary Closure
- Contraction and Epithelialization (Second Intention Healing)
Immediate closure of a wound is known as what?
Primary Closure
What are 2 types of wounds for which primary closure can be used?
- Clean wounds
- Clean-contaminated wounds
A wound is considered clean-contaminated with what 3 factors?
- Intact host defense mechanisms
- Healthy wound
- Appropriate antimicrobial treatment
How long is a wound left open for delayed primary closure?
2-5 days
Delayed primary closure is performed prior to what?
Prior to visible formation of granulation tissue.
What does delayed primary closure permit?
Repeated lavage and debridement to convert wound to clean-contaminated status appropriate for closure.
Wound closure after granulation tissue covers the wound is known as what?
Secondary closure
What are 2 types of wounds for which secondary closure is indicated?
- Deep narrow wounds
- Wide wounds
How are deep narrow wounds closed?
Secondary closure by direct apposition over granulation tissue.
How are wide wounds closed?
Secondary closure by mobilizing skin edges and advancing over granulation tissue.
Contraction and epithelialization is also known as what?
Second intention healing
How should distal limbs wounds with damage less than or equal to 25% of the circumference heal?
25-33%?
33-50%?
Greater than 50%?
- Should heal well
- Most heal well
- Will probably heal but with a wider scar
- Consider reconstruction, extended healing time or inadequate healing
What are 3 causes of cessation of wound contraction?
- Wound has healed
- Tension in surrounding skin exceeds pull of myofibroblasts
- Collagen deposition in chronic wound interferes with pull of myofibroblasts
What are 2 possible complications of second intention healing?
- Circular wound
- Wound contracture
Where should closure lines be kept in relation to lines of tension?
Parallel
What are 3 reasons for making incision lines or wound closures on the trunk parallel to skin tension lines if possible?
- Gape less
- Heal faster
- More aesthetic
When a wound has unequal sides, should sutures be closer on the shorter or longer side?
Closer on the shorter side.
Retraction of skin edges after tissue is cut is known as what?
Primary contraction
The ability to undermine skin is influenced by what 2 factors?
Why?
- Species: differences in blood supply to skin
- Breed: some breeds have a lot more loose skin than others
When undermining skin, you need to undermine below what muscle?
Cutaneous trunci muscle
What are 2 reasons to use blunt dissection when undermining skin?
- Preserves direct cutaneous vessels
- Less risk of post-operative hematoma
What are 3 functions of walking sutures?
- Advance skin over wound
- Distribute tension
- Decrease dead space
Walking sutures distribute tension over the surface area of a wound rather than what happening?
Rather than being concentrated at primary suture line.
What type of suture should be used for the walking suture technique?
How are these tied?
- Monofilament absorbable suture
- Buried
Walking sutures must engage what in order to have adequate holding power?
Must engage dermis and fascia.
With walking sutures, what is done as the skin is advanced and stretched?
Sutures are tied as skin is advanced and stretched.
Should first walking sutures be placed close to or further away from the wound?
Further away from the wound to start.
What are 3 techniques of skin stretching that enhance local movement of skin?
- Skin expanders
- Skin stretching devices
- Pre-suturing
What are 3 techniques for enhancing local movement of skin that do not involve skin stretching?
- Releasing incisions
- Multiple punctate relaxing incisions
- Adjustable horizontal mattress sutures
Pre-suturing takes advantage of what 2 properties?
- Mechanical creep
- Stress relaxation
What is a type of pattern used for pre-suturing?
Mattress sutures with stents to distribute pressure on skin.
Should the animal be sedated for pre-suturing?
Yes
What should be done to the limb after pre-suturing?
What needs to be left exposed?
- Bandage limb after applying
- Leave toes exposed
When are pre-sutures placed?
Usually placed day before surgery (less than 24 hours)
What can be done with suture lines in reference to pressure points?
Suture lines can be moved to avoid placement over pressure points.
Multiple punctate relaxing incisions are also known as what?
Mesh releasing incisions
What are 3 steps for making multiple punctate relaxing incisions?
- Undermine skin
- Place intradermal suture pattern
- Make rows of staggered full-thickness incisions beginning 1 cm from edge while keeping tension on intradermal suture
Is it better for incisions made for multiple punctate relaxing incisions to be short or long?
Short
An adjustable horizontal mattress works best in what type of wound?
Why?
- Wounds with established granulation tissue.
- Skin at edge of wound is thicker and holds suture better.
What are 3 parts to an adjustable horizontal mattress?
- Monofilament suture material
- Buttons
- Split-shot
Where are the buttons and split-shot placed with an adjustable horizontal mattress?
Placed at one or both ends.
What is done daily to the suture in an adjustable horizontal mattress?
Suture is tightened each day to enhance closure of the wound.
